Care for Homeless Patients With Inflammatory Arthritis


For a study, researchers sought to discover methods for enhancing care for this distinct patient population. They previously reported 17 homeless patients with inflammatory arthritis (15 with rheumatoid arthritis and 2 with psoriatic arthritis). They gathered follow-up information on the first 17 patients and compared it to data summarised and published about them 12 months prior. In addition, investigators designed and distributed a 100-question needs assessment survey. Around 13/17 homeless individuals and 13/17 non-homeless individuals provided 12-month clinical follow-up data. Homeless patients stayed less healthy and had more disease than non-homeless patients—poorer access to clinic appointments (80% vs. 91%, P<0.05), more emergency services usage (20 vs. 5 ED visits), fewer DMARDs use (43% vs. 100%, P<0.01), and greater steroid use (29% vs. 0%). Statistically, homeless patients had higher inflammatory markers than non-homeless patients (ESR 32 vs. 26 mm/h and CRP 17 vs. 5 mg/L), but these differences were insignificant. 78% of homeless patients were stable, 14% improved, and 7% worsened; 21% had stable, controlled disease, and 57% had stable active disease, compared to 62% and 0% of non-homeless patients (P<0.01). About 6 homeless individuals (4 RA and 2 PsA) completed the survey, while 2 declined and 9 could not be reached. All 6 had obtained accommodation, but all still faced housing insecurity; 4 (67%) had previously been homeless. 3 out of 6 (50%) individuals who were homeless and hospitalized due to an illness exacerbation received housing support. The average monthly income was $873. 5/6 (83.3%) were unable to work due to their health and were in substantial pain, negatively affecting their physical and mental health and their capacity to execute ADLs. Their “biggest need” was assessed for dental care, physical therapy, knee surgery, job, sociability due to isolation, and stable housing. The grasp of the special issues faced by rheumatoid arthritis homeless patients had improved but was still incomplete. It was vital to strengthen collaboration between street medicine providers and rheumatologists to enhance care for homeless patients, especially in light of lower outcomes than non-homeless patients.

Source:link.springer.com/article/10.1007/s10067-022-06167-2



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